The project will measure the mortality consequences of tobacco smoking and chewing among 1.3 million households (about 7.6 million people) who are already enrolled in the Indian Sample Registration System (SRS), and who will be re-surveyed every 6 months until 2014. India's SRS is a large continuous demographic survey of 7,597 small areas (4,433 rural and 3,164 urban) randomly selected from the 2001 Census. This project (among the world's largest prospective studies of adult health) is possible because of the success of our earlier NIH grant (#TW005991) which established reliable, routine, low-cost and long-term monitoring of causes of death, and which surveyed 150,000 deaths that occurred in 2001-2003. This first NIH grant also documented: (i) that 37% of males aged 25-69 smoke, with up to 9-fold variation by state; (ii) that illiterate men had a 4-fold higher risk of smoking bidis, and a 2.5 fold lower risk of smoking cigarettes than did those with grade 10 or higher education; (iii) smoking bidis or cigarettes already causes about 1 in 3 adult male deaths (a proportion equal to that seen in the United States about two decades ago); and (iv) smoking causes nearly half of tuberculosis deaths in India. Specific aims of this project (2006-2012) are to: Quantify risks for tuberculosis, heart attack, cancers and other causes in relation to male smoking and tobacco chewing and in relation to female tobacco chewing among 160,000 adult deaths at ages 25-69. > Quantify the effects of household male smoking and indoor air pollution among about 3,500 childhood respiratory deaths and about 7,500 adult female respiratory deaths. Study the trends and determinants of smoking and chewing, including cessation among 0.6 million male smokers, 0.5 million male chewers and 0.2 million female chewers. Study the correlations of tobacco with other risk factors for chronic diseases (obesity, blood pressure and lipids, diabetes) in a blood-based pilot study of 10,000 adults. Provide applied training to field staff, epidemiologists and scientists in tobacco epidemiology, including a "knowledge translation" program to convert research findings into policy and monitoring. The project builds sustainable capacity to monitor diverse tobacco hazards in a population of 1 billion at a unique scale (surveying about 0.7 million deaths from 2004-2014, of which about 0.4 million will be surveyed in the project period). Leverage of Government of India and other resources permits the study to be very low-cost (< $1/person/year). The blood-based pilot studies should enable large, representative and reliable genetic and biological epidemiological studies of premature mortality in the near future. [unreadable] [unreadable] [unreadable]